Davidsen O, Lindeneg O, Walsh M
Acta Med Scand. 1979;205(3):191-4. doi: 10.1111/j.0954-6820.1979.tb06029.x.
The efficacy of a non-narcotic analgesic is evaluated in a double-blind randomized series of patients with acute myocardial infarction (AMI). Levomepromazine or pethidine were given in 328 consecutive cases to 316 patients within 24 hours after the onset of symptoms. Levomepromazine, 12.5 mg, appeared as effective as pethidine, 50 mg, in the alleviation of pain, though the initial dose had to be higher. Nausea and vomiting were half as frequent in the levomepromazine group as in the pethidine group (p less than 0.001). The incidences of arrhythmias, lung oedema, hypotension and thromboembolic complications did not differ between the groups. The mortality rate in the first 4 weeks was 22% in the levomepromazine group and 37% in the pethidine group (p less than 0.005), and after one year 39 and 50% (p less than 0.05), respectively. It is concluded that levomepromazine is better tolerated than pethidine in AMI. This suggests that the present management of pain in AMI should be reconsidered.
在一系列双盲随机试验中，对非麻醉性镇痛药在急性心肌梗死（AMI）患者中的疗效进行了评估。在328例连续病例中，于症状发作后24小时内给316例患者使用了左美丙嗪或哌替啶。12.5毫克左美丙嗪在缓解疼痛方面似乎与50毫克哌替啶一样有效，尽管初始剂量必须更高。左美丙嗪组恶心和呕吐的发生率是哌替啶组的一半（p<0.001）。两组间心律失常、肺水肿、低血压和血栓栓塞并发症的发生率无差异。左美丙嗪组前4周的死亡率为22%，哌替啶组为37%（p<0.005），一年后分别为39%和50%（p<0.05）。结论是，在急性心肌梗死中，左美丙嗪比哌替啶耐受性更好。这表明应重新考虑目前急性心肌梗死疼痛的处理方法。
